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Recommendations Summary

DM: Vitamin, Mineral and/or Herbal Supplementation (2015)

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    DM: Advise on Vitamin, Mineral and Herbal Supplementation

    If vitamin, mineral and herbal supplementation is proposed as a diabetes management strategy, the registered dietitian nutritionist (RDN) can advise adults with diabetes that there is no clear evidence of benefit from supplementation in people who do not have underlying deficiencies. Routine supplementation with antioxidants (such as vitamins E and C and carotene) and other micronutrients (such as chromium, magnesium and vitamin D) and herbal supplements (such as cinnamon) are not advised due to lack of evidence of efficacy and concern related to long-term safety.

    Rating: Fair
    Conditional

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      The recommendation DM: Advise on Vitamin, Mineral and/or Herbal Supplementation applies when vitamin, mineral or herbal supplementation is proposed as a diabetes management strategy.
       

    • Potential Costs Associated with Application

      Costs of medical nutrition therapy (MNT) sessions and reimbursement vary. However, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      From the 2013 American Diabetes Association Nutrition Therapy Recommendations

      • There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes who do not have underlying deficiencies. Grade C
      • Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety. Grade A
      • There is insufficient evidence to support the routine use of micronutrients such as chromium, magnesium and vitamin D to improve glycemic control in people with diabetes. Grade C
      • There is insufficient evidence to support the use of cinnamon or other herbs or supplements for the treatment of diabetes. Grade C
      • It is recommended that individualized meal planning include optimization of food choices to meet recommended dietary allowance or dietary reference intake for all micronutrients. Grade E
      From the 2015 American Diabetes Association Standards of Medical Care in Diabetes

      Foundations of Care: Education, Nutrition, Physical Activity, Smoking Cessation, Psychosocial Care and Immunization
      • There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes who do not have underlying deficiencies. Grade C
      • Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised due to insufficient evidence of efficacy and concerns related to long-term safety. Grade C
      • There is insufficient evidence to support the routine use of micronutrients such as chromium, magnesium and vitamin D to improve glycemic control in people with diabetes. Grade C
      • There is insufficient evidence to support the use of cinnamon or other herbs or supplements for the treatment of diabetes. Grade E
      • It is recommended that individualized meal planning include optimization of food choices to meet recommended dietary allowance and dietary reference intake for all micronutrients. Grade E

    • Recommendation Strength Rationale

      • The 2013 American Diabetes Association Nutrition Therapy Recommendations received Grades A, C and E
      • The 2015 American Diabetes Association Standards of Medical Care in Diabetes received Grades C and E.

    • Minority Opinions

      Consensus reached.

  • Supporting Evidence

    The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).